LP
Leslie P

1 reviews | Active since Nov 2023

15 Nov 2023, 19:40

Rejection of authorisation

My wife was diagnosed with a rare condition known as Parry Romberg syndrome which in her case affected the tissue on the right side of her face and has in some parts fallen away. Currently she's struggling with excruciating pain and skin is touching the cheek bone close to the chin making it difficult for her to eat as well as smile. The surgeon has suggested fat transfer to rehabilitate the soft tissue and skin fibrosis that would ease the pain due to stem cell regeneration. My beloved Discovery Medical aid rejected the authorization for treatment stating that it is a Keloid and that this is not covered under the scheme. The operation is scheduled for tomorrow the 16/11/2023 and Discovery has rejected it without detailed reasons. I am at my wits ends and do not understand why authorisation was not granted as my premiums are paid on time. A motivation letter from the surgeon was e- mailed together with photographs depicting the seriousness of this disease. This is appalling and I'm going to refer this matter to the Medical Ombusman. I am also awaiting a detailed response from the Discovery medical review team as to why this authorisation for this operation was not granted.

0
Replies (4)
Discovery Health
Discovery Health's reply16 Nov 2023, 06:31
Official
Dear Leslie P We’ve noted your concerns and we’re investigating the matter. We’ll contact you with feedback as soon as possible.
 
Regards
Discovery Health Servicing Team
Discovery Health
Discovery Health's reply20 Nov 2023, 15:27
Official
Dear Leslie P We’ve contacted you and provided feedback on your concern. 
 
Regards
Discovery Health Servicing Team
LP
Leslie P's update21 Nov 2023, 08:38
Reviewer Update
I am most disappointed with Discovery. They have still not approved the authorisation. Instead they requested me to complete a formal dispute and they will revert within 30 days. This is pathetic and is a clear indication of their unwillingness to resolve the matter. I am yet to receive their written explanation for the initial rejection of the authorization. So much for customer feedback.
Discovery Health
Discovery Health's reply23 Nov 2023, 13:41
Official
Dear Leslie P We’ve contacted you and provided feedback on your concern.
 
Regards
Discovery Health Servicing Team